Rapid Administration of Carnitine in sEpsis

Inclusion criteria

• Suspected or confirmed infection (examples include but are not limited to: white cells in a normally sterile body fluid; perforated viscus; radiographic evidence of pneumonia in clinical symptoms; a syndrome associated with a high risk of infection e.g. cellulitis, cutaneous abscess, ascending cholangitis, toxic shock syndrome, fever of unknown origin with high suspicion of infectious etiology)
• Any two of four criteria of systemic inflammatory response as defined by the 2001 ACCP/SCCM Consensus Conference Committee;
• Recognition of septic shock and initiation of quantitative resuscitation within 24 hours of enrollment;
• Requirement of high dose vasopressors for ≥4 hours to treat shock: Norepinephrine > 0.05mcg/kg/min; dopamine >10mcg/kg/min; Phenylephrine >0.4 mcg/kg/min; epinephrine > 0.05 mcg/kg/min;
• Cumulative sequential organ failure assessment (SOFA) score of ≥ 6;
• Blood lactate level of >2.0 mMol/L.

Exclusion criteria

• Age <18 years;
• Pregnancy or breastfeeding;
• Any primary diagnosis other than sepsis;
• Established Do Not Resuscitate status or advanced directives restricting aggressive care or treating physician deems aggressive care unsuitable;
• Any history of seizures or a known seizure disorder;
• Any known inborn error of metabolism;
• Anticipated requirement for surgery that would interfere with the 12 hour infusion time;
• Active participation in another interventional study;
• Cardiopulmonary resuscitation (chest compression or defibrillation) prior to enrollment;
• Known systemic allergy to L-carnitine.
• Severe immunocompromised state (e.g. subject has neutropenia [receiving cytotoxic chemotherapy with absolute neutrophil count <500/uL or expected to decline to < 500 uL within the next three days).
• Active Treatment with Coumadin